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Dermatology condition

Vulnerability

references

Co-morbidity

Smoking

Renal impairment

Class 1

methotrexate, azathioprine, mycophenolate (mycophenolate mofetil or mycophenolic acid), ciclosporin, fumaric acid esters (or dimethyl fumarate), hydroxycarbamide, 6-mercaptourine, leflunomide, cyclophosphamide, tacrolimus, sirolimus and thalidomide.

Class 2

Biologic/monocolonal medications include –all anti-TNF drugs (etanercept, adalimumab, infliximab, golimumab, certolizumab pegol and biosimilar variants of all of these, where applicable); IL17/IL17Ra agents (secukinumab; ixekizumab; brodalumab); P40/P19 (ustekinumab; guselkumab, tildrakizumab, risankizumab) anti B cell (rituximab in last 12 months, belimumab); IL6 agents (sarilumab, tocilzumab); abatacept; IL1 (canakinumab, anakinra);

Dupilumab possibly lower infection risk than other drugs)

Class 3

novel small molecule immunosuppressants

apremilast; all JAK inhibitors (e.g.) baracitinib, tofacitinib

Corticosteroid

• dose of ≥ 20 mg (or 0.5 mg/kg) prednisolone (or equivalent) per day for more than 4 weeks

• dose of ≥ 5 mg prednisolone (or equivalent) per day for more than 4 weeks plus at least one other immunosuppressive medication, from class 1, 2 or 3 drugs as listed above

Cyclophosphamide at any dose orally or if received IV dose within last 6 months

Rituximab or infliximab when prescribed primarily for skin conditions (e.g. psoriasis or pemphigus)

single agent, standard oral immunosuppressants, class 1, 2 or 3

single biologic (e.g. anti-TNF, IL17 agent)class 2 plus methotrexate at a standard dose

single agent standard oral immunosuppressant class 1 plus hydroxychloroquine / sulfasalazine.

• Topical skin treatments (creams, gels, etc).

• Hydroxychloroquine

• Acitretin

• Alitretinoin

• Isotretinoin

• Dapsone

• Chloroquine

• 5-ASA medications (e.g. mesalazine)

• Sulfasalazine

• Only inhaled or rectally administered immunosuppressant medication, e.g. steroid inhalers

• Omalizumab